“Since the digital revolution has become mainstream, it is difficult to recall being efficient without the various digital tools at our disposal. Now, with the Internet, email, Skype, chat, texting, blogging and live streaming video, we have the ability to be in constant touch and to respond to each other in seconds from around the world. We can capture data in digital form and access it at lightning speed when we need it. Our professional and personal lives have become as close to 24-7-365 as we dare to!
With innovation and technology comes efficiency. One question one might ask is: Is there an appropriate role for technology in counselling and psychotherapy?
With technology and its availability comes a shift in the way people may want to engage in certain types counselling. It’s easy to realize the benefits of technology and how it could be used to improve accessibility and communication. In this vast country of ours, often with great distances between communities, the ability to communicate using the tools of our digital age is indeed an important adjunct to more traditional counselling methods. Not only can services be offered using technology, counsellors and therapists can become more productive as they reduce travel time.
For clients in remote and rural areas, technology provides significant benefits in terms of accessibility to counselling. Clients can access services on a more flexible schedule and avoid lengthy and costly travel, often over challenging geographic terrain. For some communities, Internet accessibility for counselling has become a major step forward in service provision. For example, in Spring 2011, the Thunder Bay Counselling Centre announced a $98,000 grant to provide eCounselling services to rural and remote areas in Northwestern Ontario.
While this move toward increased utilization of technology seems positive and certainly assists in providing accessibility and efficiency to counselling and psychotherapy services, there are potential concerns. A qualified counsellor needs to be highly adept at recognizing whether or not someone is suited for online counselling. There are issues related to the client’s preferences to different forms of online communication: How open to therapy is a person ‘online’ versus ‘in person’? What it is that brings the client to counselling? What is the client’s level of skill in communicating online?
There are also safety and ethical concerns that are brought to bear by technology in general. For example, text based communication, though technically a two-way communication, does not happen in real time. The ebb and flow of dialogue is somewhat distorted, and the positive and negative spaces within a conversation are no longer detectable. Many of the cues and visual signs that counsellors commonly tap into disappear, and there is no longer verbal intonation to hear, body language to interpret, or eyes in which to look.
The same deficit happens on the client side. Without real-time face-to-face discussion, will clients miss the non-verbal cues of understanding that they may need from the certified counsellor? Those who use email or text messaging in their day-to-day lives will know how easy it is for text-based communication to become misinterpreted. It is possible that counselling sessions done by texting or email could be subject to the same issues.
However, videoconferencing (via Skype, for example) offers something ‘closer’ to face-to-face counselling. Aside from potential Internet delays and technology ‘bumps’, counsellors and clients can enjoy the benefits of hearing verbal intonation, observing some body language and seeing each other’s eyes. And this form of counselling appears to be on the rise across Canada.
“The choice about which form of technology to use is determined by the needs of the client, their preference for communicating, and the issues”. It can make sense to use videoconferencing if someone finds writing difficult and is unable to make it into my physical office,” says Dawn Schell, an Online Counsellor. “It can take some practice to use effectively but it can be done!”
“Why do I do online counselling? So many reasons!” adds Ms. Schell. “Increased accessibility, being able to offer services to clients who would not normally be able to see me in person, a chance to creatively use technological tools to deliver services, being able to combine an interest in writing with counselling and trying new, innovative approaches.”
What about the ethical treatment of people online? As mentioned, a qualified counsellor must first assess the client’s suitability for online counselling. Assuming that assessment has taken place, there are a number of confidentiality and security issues that need to be addressed. Aside from the usual precautionary computer security measures such as anti-virus and phishing software, how does a counsellor or therapist ensure their client’s privacy and confidentiality is protected at all times?
“This type of work does require a certain amount of technical fluency on the part of the counsellor. You need to understand how the Internet works so that you can make informed decisions about security because it is vitally important that a client’s privacy and confidentiality is protected. There are excellent systems that are encrypted and password protected”, says Ms. Schell. “I think it is also important for counsellors to educate their clients about the need for them to do their part as well to protect their own privacy. For example – ensuring they have a private place or time to write/skype/chat, deleting their web browsing activity, not sharing their counselling emails with others.”
“As more technology is introduced into the counselling profession, it is important to maintain the highest standards of ethics and protection of the public. As the voice of the counselling profession in Canada, CCPA continually works towards strategies and policies which help the public benefit from accessible and affordable service, while maintaining the highest levels of confidentiality and ethical treatment,” says Lorna Martin, President of the Canadian Counselling and Psychotherapy Association. “eCounselling represents improvements in accessibility and availability for people who may otherwise avoid counselling for reasons such as travel, time constraints, ease of use, and comfort.”
The idea of eCounselling, whether by email or texting, or by using a platform such as Skype, may seem to some counsellors to be less effective given the loss of ‘face-time’ between the counsellor and the client. Others maintain that as long as there is a strong ethical foundation, the e-approach is essentially no different than counselling in more common face-to-face environments. eCounselling can be just as effective for certain types of client needs. And as long as the ethical considerations, such as confidentiality and privacy are appropriately managed, a more accessible and affordable service is made available.
“The ethical implications relate to, first and foremost, the qualifications of the counsellor and the therapeutic service they provide either face-to-face or online,” says Lynda Younghusband, PhD, CCC and Past-Chair, CCPA Ethics Committee “Certified counsellors must undergo a stringent process to ensure that they have met the ethical and legal standards set forth by the CCPA. Regardless of the delivery method for counselling, it is important that a qualified counsellor has done a thorough risk analysis of the potential client’s suitability and the application of technology in the therapeutic environment.”
As technology and its use in counselling continues to evolve, public demand may shift towards a call for increased availability and accessibility to counsellors and psychotherapists throughout Canada,” adds Ms. Martin. “We have many remote and rural parts of Canada which are in need of counselling support. If the Internet provides both an effective and low-cost way to provide service delivery to vulnerable individuals in an ethical and confidential manner, then we need to continually ensure that we move towards helping the public through technology, while protecting the public form potential harm. It’s a weighing of risks and protective factors.”
Regardless of which electronic platform is used, eCounselling or CyberCounselling represents another option for many people who wish to seek help but cannot access competent services for heuristic or geographic reasons. The counselling profession, like many other professions, will continue to be affected by new and developing technologies that help people communicate. The expectation is that counselling and psychotherapy will continue to evolve, as the profession continues to provide therapeutic environments best suited for clients’ needs. The key is accessing qualified counsellors and psychotherapists. A qualified e-counsellor will have the ability to assess the client’s potential to benefit from technology-based sessions.
To learn more about the CCPA Standards of Practice, you may order this document online at https://www.ccpa-accp.ca/ccpa-publications/.
For legal commentary on eCounselling, please see https://www.ccpa-accp.ca/wp-content/uploads/2014/10/E-counselling.pdf.
*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA